Rh neg pregnancy how to administer anti D

Question

G3P1L1D1 27yr old female with 27 weeks pog with Rhnegative blood group husband Rh positive.first pregnancy normal no anti d given second IUD at 38 wks due to fall injury no anti d given in that  pregnancy too blood group of both baby unknown.in present she develops swelling on face,leg and arms ..till 22weeks all investigation normal only mild UTI.
MY QUESTION
Can we administer inj anti D in this preg without  ICT test or it is compulsory to go with test first  and do we have to administer two anti d or one and wht cud be the cause of swelling.

Viraj R. Naik · Answer

ICT needs to be done first because if ICT is positive than anti D has no role. If ICT is negative than Anti D can be given.
For swelling, see her BPs, urinary protein (24 hours sample), lipids...If BP s are normal than check for casts in urine,0 complement levels. 
Keep watch on BPs, fall in Hb. 
Check for ICT first. If ICT is positive than Dont administer anti D. See for hydropic changes in placenta and fetus. MCA PSV of fetus. Keep monitoring . Explain the condition to couple. 
Give steroids at 32 weeks.

Rh neg pregnancy how to administer anti D

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